We have a lot of experience here among the board which I am hoping to learn from. This is the scenario for you to resolve-
You and a friend are paddling 1-2 miles offshore in moderate conditions. You friend has become ill and you are heading back to your take-out.
Your friend capsizes and does a wet exit, but when you approach to do an assisted rescue, you find that he is unconscious.
His boat and paddle are drifting away. For whatever reason, your VHF or cell phone do not work.
What would you do?
Does he have a nicer kayak than you? NM
Sounds very much like the
Kobayashi Maru scenario.
Obviously the only way to ‘win’ is to reprogram the system. 
Tow…
Tie his head to a paddlefloat (use duct tape), and tow him in… hook up his boat first though if it’s nice…
stay with person, forget his gear
If unconscious and breathing, stay with him, try to flag down help or try to get him in (depends on what seems to work). Major focus is making sire he stays breathing. Big question is what made him unconscious, and how will that play out over time.
If unconscious and not breathing, try to start CPR. Flag help if at all possible. Unfortunately, a very low expectations of any positive results.
Scenario update-
Update-
Your have found that your friend is breathing normally and you do know that he is diabetic, which might be related to his being in a coma.
There is no sign of boat traffic in the area.
hmm
I carry frosting in my PFD. If he’s an unconscious diabetic I’d clip my short tow to his shoulder strap to keep his head above water, and rub frosting on his gums, under his toungue, etc to try to get some sugar into him quick. Then I’d try to catch up with his boat (up here, getting someone out of the water is a very high priority).
If I can catch his boat I’d do a scoop rescue to get him back in his boat, and keeping him laid over my deck, I’d do a contact tow back to shore. I’d fire my flares to try to attract attention.
If I can’t catch his boat, I’d fire flares, use my signal mirror, VHF, Cell phone, whistle, etc. to try to attract help, and I’d probably rig up an outrigger with my paddle float and try to haul as much of his body as possible up on my deck, to keep him warmer.
I carry an exposure bag in my PFD, so I could put the swimmer in that bag in the water to cut down on water movement and keep him warmer.
If he’s breathing, and in coma,
you note the time, and QUICKLY check for any signs as to why the coma. You mention diabetes and might ASSUME he’s produced too much insulin and needs sugar. Kayakmedic would know better than me but from what I was trained on, if he’s unconscious you or I don’t give him juice or sugar. You get him out of the water and transported to emergency care. ( Re the coma, did he get hit by a chunk of falling ice or a goose that suddenly died and fell? (Sorry 
With no boats in sight, or working cell phone, can we use the VHF radio or SPOT that you didn’t mention? 911 needs to be contacted so medical personnel can be sent. If his boat can be reached he might have medical gear there, or at least you’d be able to transport him more easily, but HE’s the priority, not the boat (even if it is a really nice boat).
diabetics and pre-trip planning
I’ve recently done an extended trip with a type I diabetic, and before we left I asked her to tell me what I need to know about anything that could come up. One thing she told me about was her glucagon rescue kit, which is injectable sugars (sort of an epi-pen for diabetics). If she’s unconscious (and therefore can’t be given anything by mouth), the glucagon rescue injection can save her life.
Talking to your paddlers about medical issues BEFORE the paddle can inform you about stuff like this, so you know what can be done, and where the paddler keeps life-saving supplies.
Also knowing about this stuff before hand means you can be on the lookout for signs of low-sugar, like lack of concentration, trembling hands, etc, and head off the problem before it becomes a diabetic seizure.
My answer
If he was safely floating face up in calm water, quickly paddle to his boat, check to see if he has anything to aid in contacting help. Tow it back to him, quickly tie the boats together, lay him across both boats and start towards shore.
Dear Nate,
Thanks for the date re the injectable. I had an uncle who was a brittle diabetic and he went into coma several times. I saved him twice but it was close. The doctor at that time had stressed getting him to trained personnel was the most important and to not administer sugars. I’ll get updated on the current tech. Going over all medical issues first is vital.
Another consideration
If you know that you’re going to be paddling with people who have significant medical issues, you need to have more than two people on the trip. Even one more pair of hands can make a HUGE difference. I’ve been involved with an incapacitated paddler situation and it required a minimum of two paddlers other than the ‘victim’ to get him to shore safely. We were fortunate to have adequate personnel resources and the stricken paddler was conscious and able to stay in his boat. Had he been unconscious and/or out of his boat, it would have been another story.
We had functional VHFs and would have used them if necessary, but the situation wasn’t as dire as the one described by the OP. In that situation, contacting rescue services would be critical, as being stuck out on the water with an unconscious person in the water is an emergency that cannot be adequately addressed by a single paddler. The likelihood of being able to keep the victim’s head out of the water while actually being able to make any headway toward shore is very low and the possibility of reviving him is near zero. Getting outside assistance ASAP would be the primary objective.
On any trip on open water, it’s critical to make damn sure that you have functional communication equipment and readily accessible flares in case of emergencies. Emergencies can occur very quickly and unexpectedly, which is what happened to us. Our situation was further complicated by another paddler in the group that capsized and wet-exited while we were towing the stricken paddler to shore. If we hadn’t had three well-trained paddlers in the group to handle the tow and the rescue, we would have needed to call for help.
It was quite a learning experience and it reinforced the training I’d had on managing groups on the water.
Scenario update-
You do know he works in the circus. Approaching, you discover he’s the world’s smallest man. You pick him up, put him in your day hatch, and paddle back to shore.
That sounds nice and easy…
…but the likelihood of it being anything like that on the water is near zero. The PFDs that most paddlers wear will NOT support someone face up in the water. Hauling a body out of the water and onto the decks of boats would be nearly impossible for one person to accomplish, especially if the rescuer is smaller than the victim. Stir in a bit of rough water or bad weather and all those plans go right down the toilet.
I honestly don’t mean to pick on you, but your response highlights the unrealistic capabilities that many paddlers delude themselves into believing they possess. Trust me, unless you’ve actually experienced such an emergency - or at least simulated it in training - you have no idea of exactly how difficult on-water rescues can be. Two things you can count on is that they will never be as simple as they may sound on paper and the conditions on the water will almost never be in your favor. You absolutely cannot rely on a best-case scenario, as it would be a matter of pure luck if it actually happened. If that’s your rescue plan, you’re screwed!
I strongly urge everyone to read the book “Sea Kayaker - Deep Trouble”, as it’s the standard text on what actually does happen in the real world of sea kayaking emergencies. It does a great job of pointing out how seemingly simple mistakes in judgment, preparation, clothing and equipment can lead to catastrophic situations. The point is not to frighten people away from sea kayaking but rather to serve as a wake-up call that complacency has no place on the water.
More importantly, get some on-water rescue training under realistic conditions of wind and waves, not just paddle float and/or assisted rescue practice on a flat pond. Check with local clubs and outfitters to see if they offer skills sessions or courses on rescues. While you should cover the basic assisted and self rescues, go beyond that and practice “incapacitated paddler” rescues, “multiple capsize” and “all-in” scenarios with various size groups. Spend considerable time setting up tows and actually towing, as that can be complex and difficult as well. Let everyone play the roles of rescuer AND victim, as you can gain a lot of perspective when you’re the one being rescued and provide valuable feedback to your rescuers and the class afterward.
It was a real eye-opener for me when I went through training and later when teaching the same course, I saw the exact same realization on the face of every single student. Until you’ve actually confronted rescue scenarios, you simply cannot understand the difficulties involved.
BTW, I found that training and teaching these skills was a heck of a lot of fun! The knowledge and skills you gain will make you a smarter, better paddler.
not realistic
In actuality - you paddle close to the paddler, extend your prayers, the miracle happens, maidens cry, children happily eat ice cream, while you and your partner paddle into the rising sun ( - setting sun might have a more sinister meaning).
Now, for the more serious note. Have you, wilderness first aid types, ever looked up statistics on how many people requiring CPR survive in urban environment, where qualified emergency services are just a cell phone away? How long does a typical CPR last? How long does the ambulance take to get there? You know, the real world, not the “you get A for an effort” classroom?
Yep
And it sucks. CPR doesn’t revive people, typically. It just keeps their brain perfused for a little longer. If someone has no pulse (and isn’t a lightening strike, a RECENT drowning, or a child) the chances that chest compressions will do anything by itself are nearly zero. (Those other three cases have considerably better revival rates).
That said, what else are you going to do? (assuming you don’t have room in your kit and budget for an AED) All you can do in the backcountry/ocean is start CPR and get help as soon as possible. But don’t put yourself or others at risk, just to do CPR on an older person who keeled over on the water. Priorities are Self, Partners, Public, then Victim. Knowing that CPR has a very low success rate may help you properly evaluate the relative risks/benefits when considering a heroic rescue effort.
Moreover…
– Last Updated: Sep-20-10 10:55 AM EST –
...has anyone considered the near impossibility of effectively administering CPR on the water? A single paddler sitting in a kayak simply cannot do it, except perhaps on a very small child. Even with a group of rafted boats, it's very difficult and by the time you get the boats in position and secured together, and drag the victim out of the water, it would probably be too late. In the Wilderness First Aid courses I've taken, we were taught CPR, but the instructors also pointed out these limitations for kayakers.
BTW, has anyone seen the new "Continuous Chest Compression" method for CPR? There's no mouth-to-mouth and the claim is that it's substantially more effective.
http://www.youtube.com/watch?v=E5huVSebZpM
on that claim
It is not more effective, but the wording is very careful. The headlines associated with “the breakthrough” study were “as/equally effective”. Again, in the US, where people are more squeamish about anything, the results were more convincing
In the other experiment, the Swedish EMS system randomly assigned about 1,300 victims of cardiac arrest to the two alternatives. In the hands-only group, 8.7 percent of people survived at least 30 days, compared with 7 percent of those getting conventional CPR.
Some quotes from media:
“There is inherent appeal to chest compressions alone because of the challenges of doing the rescue breathing,” said Thomas D. Rea, a physician at the University of Washington, in Seattle, where one of the studies was done. “If we can simplify the approach, I think we may enable more laypeople to perform CPR in a cardiac arrest.”
And,
Several experts said, however, that rescue breathing is essential for children in cardiac arrest, and for people who have suffocated or drowned. That’s because in them breathing stops before the heart, and restoring respiration might be enough to bring them back to life.
The question was
What would I do. Like I said IF he was floating face up in CALM conditions…
If was not face up or NOT calm obviously that would not work. As to wrestling him up onto a boat. Few people are bigger than me and I have wrestled an unconscious person up and out of the water before. Granted it was not onto a kayak.
You are 1 to 2 MILES off shore… Your options are EXTREMELY limited. IF the person is face up, your comm units are down… perhaps his work… thats the BEST you can hope for. Perhaps he has a paddle float in the boat. 2 paddle floats(yours and his) can go a long way to keep the person up out of water. If at all possible… get his boat!!! Even if you can’t get him out of the water. a paddle strapped across two boats, tie him so he floats between the boats…
Having MORE GEAR gives you more options.
Out of luck
Paddling well offshore (miles) is a lot safer with two people than solo. The second person allows you to overcome many problems that might prove too much for a solo paddler.
But if way offshore, with one of the two in the water unconscious, with no signalling/communications, the odds of more than one survivor are quite low.
I would make an attempt to keep his head above water, if I could do so while remaining upright. Probably try to haul his head and upper body into my lap. As long as I could maintain this without getting too tired to get to shore myself, I would wait for my friend to revive, or for a boat to miraculously come upon us. Then, before too long, I would do what my buddy would want me to do, get to shore alone.